Tandem Autologous Stem Cell Transplantation Improve Outcomes in Multiple Myeloma Patients with high risk factors: A Systematic Review and Meta-Analysis

Abstract Background This study aims to conduct a systematic review and meta-analysis to assess the differential effects of tandem or single autologous stem cell transplantation (HDT/ASCT) in multiple myeloma (MM) patients. Methods A systematic literature searched was performed on Pubmed, Cochrane, Embase. RCTs comparing single HDT/ASCT with or without consolidation therapy and tandem transplantation were included into network meta-analysis. Results A total of 8 RCTs was included into meta-analysis. The combined HR was 0.58 (95% CI: 0.43 to 0.80, P = 0.001) and 0.70 (95%CI: 0.54 to 0.90, P = 0.006) indicating tandem HDT/ASCT might significantly PFS and OS benefit for patients with at least one adverse factor. Results of network meta-analysis indicated there was no significant effect between tandem HDT/ASCT and single HDT/ASCT with consolidation therapy for PFS and OS. Tandem HDT/ASCT could reach a statistically significant VGPR or better response benefit compared with single HDT/ASCT (RR = 1.18, 95% CI: 1.05 to 1.32, P = 0.006). No significant difference in the risk of TRM between tandem HDT/ASCT and single HDT/ASCT group. Conclusions The results of meta-analysis showed a superior PFS and OS with similar safety among tandem HDT/ASCT and single HDT/ASCT in high risk patients. Tandem HDT/ASCT might be considered as an alternative for high risk patients.